| Objective:Cholecystolithiasis is a common disease both at China and abroad.Cholecystolithiasis is also one of the most frequently treated diseases in hepatobiliary surgery.Patients with gallstones usually present with recurrent pain in the right upper quadrant or biliary colic,and their quality of life is severely affected.Since about 1882,Langenbuch,Germany proposed the famous "hot bed theory",cholecystectomy has been regarded as the "gold standard" for the clinical treatment of gallstones.Doctors and scholars at home and abroad have also made many attempts to retain patients' gallbladders.However,they have not achieved good results for various reasons.In recent years,with the emergence of technologies such as laparoscopy,fiber choledochoscope and electronic choledochoscope,the concept of gallbladder preservation in China has re-emerged and developed,and gallbladder surgery has also been promoted and regulated.Endoscopic minimally invasive gallbladder preservation surgery is one of the important treatment methods for gallbladder stones because it can retain the functional gallbladder and is more in line with the psychological expectations of patients.However,due to the high rate of recurrence of stones after surgery and the risk of gallbladder cancer,the concept of taking stones with gallbladder preserved is not accepted by all doctors.Therefore,how to grasp the indications of gallstone-preserving surgery and estimate the recurrence rate of patients has important clinical significance.This study aims to provide a reference for the selection of surgical methods for gallstones by studying the structure and function of gallbladder and bile components on gallstone formation and recurrence,and provide a basis for standardizing the indications for gallstone preservation and predicting the recurrence rate of postoperative stones.Methods:1.Recruit healthy volunteers.Using color ultrasound diagnostic apparatus,test the maximum length(L),width(W)and height(H)of the gallbladder of 20 subjects in daily life and calculate the gallbladder volume(V=0.523×L×W×H)before breakfast,1h after breakfast,2h after breakfast,before lunch,1h after lunch,2h after lunch,before dinner,1h after dinner,2h after dinner,before bed(22:00),midnight(0:00)and 3 o'clock in the morning,analyze the changes of the gallbladder volume of the subject within 24 hours.2.Set the patients without gallbladder stones and remove the gallbladder as the control group.Set the patients who receive the gallstone-preserving surgery as the experimental group2.Patients with gallbladder removal without cholecystolithiasis were set as the control group,patients who underwent gallstone removal surgery as experimental group 1,and patients with stone recurrence within 1 year after gallstone removal surgery were experimental group 2.Take paraffin sections of gallbladder pathological specimens and measure the expression of nerve fibers,blood vessels,muscle fibers and leptin receptors in gallbladder specimens by immunohistochemistry,and evaluate the relationship between the expression of nerve fibers,blood vessels,muscle fibers and leptin receptors in gallbladder tissues and gallstones.3.Bile specimens from 3 groups of patients were retained during the operation,and the concentration of phospholipids,cholic acid,total bilirubin,direct bilirubin,cholesterol in bile was detected by Elisa method,and evaluate the relationship between the bile components and gallstones.Results:1.The normal human gallbladder is in a diastolic state before three meals.The gallbladder is in a contracted state within 2 hours after breakfast and lunch,and within 4 hours after dinner.From 22:00pm to the breakfast next day,the gallbladder was in a state of relaxation.2.Compared with the control group,the experimental group 1 had increased leptin receptor,increased number of microvessels,decreased number of muscle fibers,and decreased number of nerve fibers(P <0.05).The differences were statistically significant.Compared with experimental group 1 and experimental group 2,there was no statistically significant difference in leptin receptor,microvessel number,muscle fiber number and nerve fiber number.3.Compared with the control group and the experimental group 1,the cholesterol concentration in the bile of the experimental group was significantly increased(P<0.05),and there was no statistically significant difference in the concentration of phospholipid,bile acid,total bilirubin and direct bilirubin in the bile(P> 0.05).Compared with experimental group 1,experimental group 2 had a higher cholesterol concentration in bile(P <0.05),and there was no statistically significant difference in the concentration of phospholipid,bile acid,total bilirubin and direct bilirubin in bile(P > 0.05).Conclusion:1.The normal human gallbladder is in a diastolic state before three meals.The gallbladder is in a contracted state within 2 hours after breakfast and lunch,and within 4 hours after dinner.From 22:00pm to the breakfast next day,the gallbladder was in a state of relaxation.2.Patients with gallbladder stones have increased leptin receptors,increased number of microvessels,decreased number of muscle fibers,and decreased number of nerve fibers in gallbladder tissues than those without gallstones;these data have no significant correlation with the recurrence of gallstones.3.The cholesterol concentration in the bile of patients with gallstones is higher than that without gallstones,and the cholesterol concentration in patients with gallstones relapse after gallstone removal is further increased.The concentrations of phospholipids,cholic acid,total bilirubin and direct bilirubin in bile had no obvious correlation with gallstones. |
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